JIDAM “An Official Journal of IDA - Madras Branch” ©2022. Available
online

ISSN No: 2582-0559

Volume No: 9, Issue No: 1

CASE REPORT

SEMIPRECISION ATTACHMENT RETAINED CAST PARTIAL

DENTURE FOR REHABILITATION OF GERIATRIC PATIENT-

A CASE REPORT

Dr. Asmath Jehan, Dr. Ahila Singaravel Chidambaranathan, Dr. Muthukumar Balasubramanium

Department of Prosthodontics. SRM Dental College,SRM University, Ramapuram, Chennai, Tamilnadu, India.

DOI: 10.37841/jidam_2022_V9_I1_03

Address for Correspondence

Dr. Ahila Singaravel Chidambaranathan, MDS, Professor,

Department of Prosthodontics.

SRM Dental College,

SRM University, Ramapuram, Chennai, Tamilnadu,

India. Email:

ahilasc@yahoo.co.in

Received : 11.01.2022 Accepted : 02.03.2022

First Published: 05.03.2022 Published : 30.03.2022

ABSTRACT

Prosthetic  rehabilitation  is  of  utmost  importance  for  a
geriatric  patient  for  their  proper  nutrition  and  good
health,  so  that  the  quality  of  life  will  improve,  both
functionally  and  socially,  thereby  improving  their
confidence and self-esteem. In a geriatric patient due to
their  medically  compromised  health  condition  where
implant  is  contraindicated,  rehabilitation  can  still  be
done.  This  case  report  describes  a  patient’s  oral  status
with  Kennedy’s  class  II  modification  1  edentulous
space in mandibular arch was successfully rehabilitated
with  semi-precision  attachment  retained  RPD  and  a
long  span  fixed  dental  prosthesis  in  the  opposing
maxillary arch.

KEYWORDS:

Prosthodontic rehabilitation, Semi-

precision attachment, distal extension edentulous space,
Bar and study attachment, removable- fixed partial
denture.

Volume No: 9, Issue No: 1

Asmath et al: Semiprecision attachment retained cast partial denture for rehabilitation of geriatric patient- A case report

Prosthetic rehabilitation plays a crucial role in restoring

geriatric patients with multiple missing teeth. Patients with

comprising health conditions with relative contraindications

to implant surgery can still be rehabilitated effectively with

fixed prosthesis with precision attachment with removable

partial denture in distal extension thereby improving in

drastically diminishing the quality of life of such geriatric

patients, both functionally, esthetically and socially

providing confidence and also functionally improving the

nutrition of the patients.

Rehabilitating

implant

supported

prosthesis,

though

desirable, are not always feasible for reasons such as

compromised health condition, age, and high treatment cost.

In such cases, prosthodontic rehabilitation plays a

fundamental role in rehabilitation. Conventional fixed

denture prosthesis is not possible in the absence of distal

abutment. Comparatively favorable prosthodontic outcome is

still possible with all the limitations. One such treatment

option is FPD with attachment retained RPD.

Attachments

can be intra-coronal and extra-coronal. Intra-coronal

attachments have male and female components attached

within the coronal structure of the abutment tooth. Extra-

coronal attachments with male and female components

attached to the external surface of the abutment tooth.

2,3

This

is a case report of a patient with Kennedy’s class II

modification 1 in mandibular arch rehabilitated by fixed

partial denture with semi-precision attachment retained cast

partial denture and long span fixed dental prosthesis in the

maxillary arch.

CASE REPORT

A 70-year-old female patient came to the Department of

Prosthodontics, SRM Dental College, Ramapuram, Chennai,

India

with

chief

complaint

missing

teeth

11,17,21,24,25,27,35,36,46,47 and unable to eat food.

Patient has history of diabetes, hyperthyroidism and

hypertension. The clinical condition was diagnosed as

Kennedy´s class II modification 1 in mandible and

Kennedy´s class III modification 1 in maxillary arch (Fig 1).

Fig 1: Pre-operative Photo

There was generalized attrition with pain in relation to 16

which was supra-erupted, radiographically showed pulpal

exposure hence intentional root canal treatment was

performed. Treatment options given were

1)Implant supported prosthesis for upper and lower arch

2)Removable partial denture for lower arch and FPD/

implant for upper arch.

3)Semi precision attached cast partial denture for lower and

FPD for upper arch.

Finally, last option was decided.

TREATMENT PROCEDURE

1 Diagnostic impressions with alginate impression material

(Zelgan plus, Dentsply) was made and cast was poured and

articulation was done. (Fig 2)

Fig 2: Diagnostic cast

2.Tooth preparation for 12, 13, 22, 23, 26, 34, 35, 44 and 45

was done and provisional restoration was given.

3 Definitive impression was made with polyvinylsiloxane

impression material (Aquasil, Dentsply) and cast with die

INTRODUCTION

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Asmath et al: Semiprecision attachment retained cast partial denture for rehabilitation of geriatric patient- A case report

stone was made. Interocclusal records was made and the

casts were articulated. (Fig 3)

Fig 3: Final impression

4.Wax patterns were fabricated for metal ceramic fixed

partial denture for maxillary and mandibular arch. Male

components were attached to the axial surface of the

abutment with the help of a dental surveyor. This was

followed by investing and casting.

5.The fit of the upper framework was verified in the master

cast and in the patient’s mouth. Framework was sand blasted

and followed by ceramic build up. The cementation of

definitive prosthesis for upper arch was done. (Fig 4)

Fig 4: Bite registration

6.Inter-occlusal record was made with inter-occlusal record

impression material along with the upper metal ceramic

fixed partial denture. (Fig 5)

Fig 5: Fixed partial denture

7.The wax pattern of the metal framework was fabricated

using a dental surveyor and lingual bar major connector

framework was made. The framework was invested, casted

and the female component was inserted in the tissue surface

of metal framework. (Fig 6)

Fig 6: Metal copings

8.The fit and retention of the metal framework was verified

in the patient’s mouth and jaw relation was done. (Fig 7)

Fig 7: Metal try-in

Teeth arrangement and wax try in was done. The processing

of the denture was then followed by finishing and polishing

the removable partial denture. (Fig 8)

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Asmath et al: Semiprecision attachment retained cast partial denture for rehabilitation of geriatric patient- A case report

Fig 8: Completed prosthesis

9. The porcelain fused to metal fixed partial denture was

cemented with GIC type 1 luting cement (GC, Gold label)

and the denture was inserted. (Fig 9) Patient was recalled

after 24 hours for postinsertion check-up.

Fig 9: Post operative Photo

DISCUSSION

An attachment is a mechanical device for the fixation;

retention and stabilization of dental prosthesis. In 1906, Dr.

Herman E. S. Chayes designed the first attachment and

positioned the attachment lingually, but eventually a

mesiodistal position was finally agreed for its better

esthetics.

First semi precision attachment was constructed

by Gillete in 1923. Attachments are classified into precision

and semi-precision attachments based on the method of

fabrication and tolerance to fit.

While prefabricated

attachments are called as precision attachments, the

attachments processed in laboratory are called as

semiprecision attachments. Precision attachment is made of

precious metal and machined to very close tolerances, hence

is more precise than laboratory fabricated attachment.

Semiprecision attachments are usually custom fabricated in

base metal alloys with metal fixed to a fixed or removable

partial denture that fits into a matrix in a cast coping,

allowing partial movement of the components. Their main

application is for distal extension prosthesis to allow partial

movement of the prosthesis.

CONCLUSION

Use of semiprecision attachments based on the patient

requirements and gives a better alternative approach in

rehabilitating geriatric cases with better retention and

esthetics compared to the conventional removable partial

denture.

FINANCIAL SUPPORT AND SPONSORSHIP:

Nil

CONFLICTS OF INTEREST:

There are no conflicts of interest.

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Burns DR, Ward JE. A review of attachments for

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